congenical rubella syndrome surveillance in combodia

CONGENITAL RUBELLA SYNDROME SURVEILLANCE IN CAMBODIA (Preliminary results) Dr.LORN TRY Patrich General Pediatrician Kampong-Cham Provincial Hospital,Cambodia Email: ltpt12@hotmail.com Dr.LT Patrich,General Pediatrician INTRODUCTION • CRS is characterized by multiple defects, particularly to the brain, heart, eyes and ears  congenital heart diseases, hearing impairment , visual impairment and mental retardation. • Treating the illness and disabilities associated with CRS is very costly. • Even well treated, many cases may not fully recovered. • Surveillance of congenital rubella syndrome (CRS) requires a comprehensive system to detect suspected CRS cases in infants who present to different health services. • Most developed countries have established surveillance of CRS with national disease notification program. • In developing countries, CRS cases are likely to be under- reported especially where a high proportion of births occur at home and neonatal and infant deaths are often unreported. Dr.LT Patrich,General Pediatrician INTRODUCTION • In Cambodia data from EPI and NIPH in 2011: total of 480 lab confirmed rubella cases • Around 20% of these cases aged > 15 years some pregnant women are infected, and their children will be born with congenital rubella syndrome (CRS). • As of 2009, 67% of WHO member states have introduced Rubella vaccines into their routine childhood program. • In Western Pacific Region, 81% of the 37 member countries and areas have introduced Rubella Vaccine. • However, RV has not yet been introduced into Cambodia. Dr.LT Patrich,General Pediatrician Objectives of surveillance • To identify and document the burden of CRS cases in the two sentinel hospitals : NPH and Kampong-Cham Provincial Hospital • To monitor the effectiveness of rubella vaccination programs. Dr.LT Patrich,General Pediatrician • Takeo METHODS • Retrospective studies • Between 1.September 2011 and 30.July 2012 (11 Months) • Age < 12 Months • 2 Sentinels sides : NPH and Kg. Cham hospital Dr.LT Patrich,General Pediatrician Inclusion criteria • Detects at least : Two of the complications listed in (A) OR One in (A) and one in (B): A. B. – Congenital heart disease - Purpura – Cataract(s) - Splenomegaly – Hearing impairment - Microcephaly – Congenital glaucoma - Developmental delay – Pigmentary retinopathy - Meningoencephalitis - Radiolucent bone disease - Jaundice within 24 hours after birth Dr.LT Patrich,General Pediatrician Key data to be collected in the investigation form • Infant’s identification • Patient's date of birth, Sex, name of parents, address, phone number of parents • Date of notification, name and phone number of notificator/investigator • Date of investigation • Clinical signs and symptoms • Maternal history : age, febrile rash illness or exposure to febrile rash illness during this pregnancy, vaccine history Dr.LT Patrich,General Pediatrician Dr.LT Patrich,General Pediatrician • Six months, We have Identified 20 suspected cases of CRS (NPH=9, Kg-Cham Hospital=11) using WHO recommended case definition (inclusion criteria) Dr.LT Patrich,General Pediatrician [...]... public health problems in Cambodia • 20 CRS cases are identified during a 6 month period from Sept 2011 to Feb 2012 • Most frequent Congenital heart disease(75%) and Cataract (60%) • Most frequent Mother has rash illness during pregnancy in first trimester (90%) • Hearing loss present at birth is often not detected until a later age • Should EPI consider Introduction of Rubella Vaccine into Cambodia? Dr.LT... 11:340, Congenital rubella syndrome and autism,spectrum disorder prevented by rubella, vaccination - United States, 2001-2010 4 Ortega García et al Prenatal exposure of a girl with autism spectrum disorder to ‘horsetail’ (Equisetum arvense) herbal remedy and alcohol: a case report Journal of Medical Case Reports 2011, 5:129 5 Guidelines for surveillance of congenital rubella syndrome and rubella Field test... Sokhamony Kampong-Cham provincial Hospital 7 Dr.RICHARD JOHN WILLIAM (CAM) WHO Dr.LT Patrich,General Pediatrician REFERENCES 1 BMC Infectious Diseases, Congenital rubella syndrome in Iran , 2005, BMC Infectious Diseases 2005, 5:44 doi:10.1186/1471-2334-5-44 2 BMC Public Health 2009, 9:269, Rubella seroprevalence among primary and pre- primary school pupils at Moi's Bridge location, Uasin Gishu District, Kenya,... 2000 – 2500 g 9 (45%) > 2500 g 1 (5% ) Total 20 Dr.LT Patrich,General Pediatrician CLINICAL SIGNS ( N0 = 20) CHD 15 (75%) Cataract 12 (60%) Purpura 9 (45% ) Jaundice 6 (30%) Splenomegaly 2 (10%) Dr.LT Patrich,General Pediatrician RISK FACTOR ( N0 = 20) Mother has rash illness during pregnancy First trimester Expose during pregnancy Dr.LT Patrich,General Pediatrician 18(90%) 15(75%) 9 (45%) Dr.LT Patrich,General... Journal of Medical Case Reports 2011, 5:129 5 Guidelines for surveillance of congenital rubella syndrome and rubella Field test version, May 1999, DEPARTMENT OF VACCINES AND BIOLOGICALS, World Health Organization, Geneva 1999 (www.who.int/gpv-documents) Dr.LT Patrich,General Pediatrician . women are infected, and their children will be born with congenital rubella syndrome (CRS). • As of 2009, 67% of WHO member states have introduced Rubella vaccines into their routine childhood. illness during pregnancy in first trimester (90%) • Hearing loss present at birth is often not detected until a later age. • Should EPI consider Introduction of Rubella Vaccine into Cambodia? Dr.LT. Guidelines for surveillance of congenital rubella syndrome and rubella Field test version, May 1999, DEPARTMENT OF VACCINES AND BIOLOGICALS, World Health Organization, Geneva 1999 (www.who.int/gpv-documents) Dr.LT